Medication Summary

Research into the pathophysiology of primary blast injury (PBI) continues. On a cellular level, shock waves produce an inflammatory response. Interleukin 8 is released, causing mobilization of polymorphonuclear leukocytes (PMNs) into the systemic circulation. The release of proinflammatory cytokines induces the expression of the CD11b receptor complex on the PMN surface, leading to adhesion at the site of injury. Select free-radical scavengers and inhibitors of inflammatory pathways are promising in phase I animal trials. In addition, blast injury to the lungs causes levels of inducible nitric oxygen synthase (iNOS) to increase in the brain, causing brain injury. The iNOS inhibitor aminoguanidine appears to be effective when administered to mice either before or 1 hour after the blast, but human data are lacking.

Although animal models suggest that bradycardia and hypotension observed in primary blast injury may be vagally mediated, it would be premature to recommend atropine at this time.

Broad-spectrum prophylactic antibiotics should be considered for patients with open wounds from blasts. Tetanus immunization status should be confirmed, and tetanus toxoid should be provided as required.

Use of copper sulfate solution for management of burns contaminated with the military munition WP is described in Emergency Department Care.

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Media Gallery

Blast injuries. Idealized graph of a blast pressure wave over time. Courtesy of Bowen TE and Bellamy RF, eds, Emergency War Surgery. Washington, DC: United States Government Printing Office, 1988.
Blast injuries. Estimated human tolerances for single, sharp, rising blast waves. Courtesy of Bowen TE and Bellamy RF, eds, Emergency War Surgery. Washington, DC: United States Government Printing Office, 1988.

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Author

Andre Pennardt, MD, FACEP, FAAEM, FAWM Professor and Vice Chairman for Operational Medicine, Department of Emergency Medicine and Hospitalist Services, Georgia Regents University

Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Florida Medical Association, National Association of EMS Physicians, Special Operations Medical Association, International Society for Mountain Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US, Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Eric J Lavonas, MD, FACEP Associate Director, Rocky Mountain Poison and Drug Center; Assistant Professor, University of Colorado School of Medicine

Eric J Lavonas, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, Phi Beta Kappa, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

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